What is the process for approving a Social Security Disability claim?

The process for approving a Social Security Disability claim involves many steps.

First you must file a Social Security and/or SSI disability claim. You might go to your local Social Security office, call the toll free Social Security number (1-800-772-1213), or you may even go online to file a disability claim. However, should you choose to file for Social Security Disability online, you will not be able to file an SSI claim. At this time, SSI applications are not available online.

Consequently, after submitting information online for SSI (this is considered a lead and not an actual application), the local Social Security office will contact you to set up a time to talk to you about potential SSI benefits and other documentation required for your disability claim.

If you do not hear from a Social Security representative in a reasonable amount of time, you may want to call the local Social Security office to check the status of the disability claim.

Once an application has been taken for Social Security Disability, the claim will be forwarded to the state disability agency (which is responsible for making medical disability determinations for the Social Security Administration) for a medical determination.

Remember that disability is based on your inability to work and earn a substantially gainful income due to your medical condition (or conditions) for a period that has lasted twelve months, or is expected to last twelve months.

Many factors are considered in the medical determination such as what your work activity has been for the past fifteen years, your age, your medical conditions, and what functional limitations have been caused by your medical condition or conditions.

If your Social Security Disability claim has been denied, you may appeal the medical decision within sixty days (plus five days for mailing) of your denial notice. The second level of the disability claims process is known as reconsideration or review (it currently goes by different names depending on which state you live in).

Do not become discouraged if you are not allowed at this level, as only a small percentage of disability denials are reversed at this level. Of course, you will once again have sixty days (plus five mailing days) to appeal your disability denial.

The third level of the disability approval process is known as the hearing request. At a Social Security Disability hearing, you will have your disability claim reviewed by an administrative law judge (ALJ). Also, you will be able to present your case and explain how your medical conditions have caused you to be unable to work at a substantial level.

Keep in mind that the ALJ has the ability to take more factors into consideration while making a medical determination than the state agency disability examiners have at their discretion.

Sometimes it is difficult to objectively present your own disability case, therefore you may wish to have a representative present your case facts to the judge. Statistics seem to indicate that disability claimants with representation are more likely to receive a medical allowance or approval at a disability hearing, particularly if they are represented.

About the Author: Tim Moore is a former Social Security Disability Examiner in North Carolina, has been interviewed by the NY Times and the LA Times on the disability system, and is an Accredited Disability Representative (ADR) in North Carolina. For assistance on a disability application or Appeal in NC, click here.

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